VA Health Care: VA Medical Centers Need to Improve Monitoring of High-Risk Patients

The Associate Chief Medical Director for Operations emphasized the importance of this recommendation in a June 3, 1994, VHA conference call and an August 29, 1994, memorandum to all facility directors. Nursing Service also addressed this recommendation in a March 1994 conference call.

VHA asked facilities representing urban, rural, psychiatric, and general medical and surgical groups to submit information on how high-risk patients are identified. VHA central office staff reviewed and compiled this information. It was attached to the Associate Chief Medical Director's August 29, 1994, memorandum to all medical center directors.

VHA conducted policy reviews that met the intent of this recommendation between January and April 1993. As incidents involving missing patients are reported through the Patient Incident Reporting program, regional quality assurance staff review that particular facility's missing patient policy to ensure compliance with the Central Office directive. This activity is an ongoing effort and no additional actions are planned.

Staff of the Office of the Associate Chief Medical Director for Operations, with assistance from the Central Region, the Medical Information Resources Management Office, and the Hines Information Systems Center, developed a Missing Patient Register. The system was alpha and beta tested in the Central Region and scheduled for nationwide installation into the Decentralized Hospital Computer Program (DHCP). The registry has automated screening features that will alert a VA medical center when a patient reported as missing presents to any facility for treatment. Registering a veteran for inpatient or outpatient care will automatically trigger a search of the missing patient registry systemwide.